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Salvi S.,Chest Research Foundation | Gogtay J.,Cipla | Aggarwal B.,Cipla
Expert Review of Respiratory Medicine | Year: 2014

The pressurized metered dose inhalers and dry powder inhalers are the most widely used devices for inhalation therapy in asthma and chronic obstructive pulmonary disease; each of these devices have certain advantages and disadvantages that impact their use. Motivation from the virtues of these devices led to the development of breath-actuated or breath-activated metered dose inhalers. A history of the breath-actuated inhalers, the development and technical aspects, studies about the usability, inhalation technique and patient preference, lung deposition and impact on lung function are presented in this review article. This review presents the use of breath-actuated inhalers in asthma and chronic obstructive pulmonary disease and in children and elderly; and a brief economic evaluation aims to put the clinical efficacy and ease-of-use of the breath-actuated inhaler into perspective by understanding the long-term cost benefits associated with this device. © 2014 Informa UK Ltd.

Shah S.,Bj Medical College And Sassoon General Hospitals And Chest Research Foundation | Nahar P.,Bj Medical College And Sassoon General Hospitals And Chest Research Foundation | Vaidya S.,Bj Medical College And Sassoon General Hospitals And Chest Research Foundation | Salvi S.,Chest Research Foundation
Indian Journal of Medical Research | Year: 2013

Background & objectives: There are very few studies that have investigated the muscle strength and endurance of upper limbs (UL) in chronic obstructive pulmonary disease (COPD). We undertook this study to measure and compare the skeletal muscle strength and endurance of UL in COPD patients and age matched healthy controls and to study the association between lung function parameters and UL muscle strength and endurance. Methods: Forty one COPD patients and 45 height and weight matched healthy subjects of the same age group were studied. UL skeletal muscle strength and endurance were measured using the hand grip dynamometer test. Forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), forced expiratory fow during 25-75% FVC (FEF25-75%) and peak expiratory fow rate (PEFR) were measured. The handgrip muscle strength and endurance between the two groups were compared and correlations between FVC and FEV1 with muscle strength and endurance were analyzed. Results: The mean handgrip strength and mean muscle endurance in COPD patients were signifcantly lesser than the normal subjects in both males and females (P<0.001). There was signifcant positive correlation between muscle strength and FVC in males (r2=0.32, P<0.05); and between muscle strength and FEV1 in females (r2=0.20, P<0.05). Interpretation & conclusion: The study showed that the handgrip muscle strength decreases as the FVC and FEV1 decrease in patients with COPD. Identifying those patients who have reduced strength and endurance will allow early interventions targeted at improving the quality of life of the patient.

Khafaie M.A.,Health Science University | Salvi S.S.,Chest Research Foundation | Ojha A.,Technogreen Environmental Solutions | Khafaie B.,Islamic Azad University at Omidieh | And 2 more authors.
Diabetes Care | Year: 2013

OBJECTIVEdTo study the association between ambient air pollutants and serum C-reactive protein (CRP) concentration in 1,392 type 2 diabetic patients in Pune, India. RESEARCH DESIGN AND METHODSdA cross-sectional study was conducted that linked daily time series of ambient air pollution data (obtained fromcentral monitoring sites) and plasma CRP concentration in type 2 diabetic patients from the Wellcome Trust Genetic (Well-Gen) Study, recruited between March 2005 and May 2007. Air pollution effects on CRP concentration were investigated with delays (lags) of 0-7 days and multiday averaging spans of 7, 14, and 30 days before blood collection adjusted for age, sex, BMI, hemoglobin, fasting plasma glucose, treatment with agents with anti-inflammatory action, season, air temperature, and relative humidity. RESULTSdMedian CRP concentration was 3.49 mg/L. For 1 SD increase in SO2 and oxides of nitrogen (NOx) concentrations in ambient air, a day before blood collection (lag1), we observed a significant increase in CRP (9.34 and 7.77%, respectively). The effect was higher with lag2 (12.42% for SO2 and 11.60% for NOx) and wore off progressively thereafter. We also found a significant association with multiday averaging times of up to 30 and 7 days for SO2 and NOx, respectively. No significant associations were found between particulate matter with an aerodynamic profile#10 mm (PM10) and CRP concentration except in summer. The association was significantly higher among patients with a shorter duration of diabetes, and in those not on statin and thiazolidinedione treatment. CONCLUSIONSdWe demonstrate, for the first time, a possible contribution of ambient air pollution to systemic inflammation in Indian type 2 diabetic patients. This may have implications for vascular complications of diabetes. Copyright © 2013 by the American Diabetes Association.

Salvi S.,Chest Research Foundation
Clinics in Chest Medicine | Year: 2014

The development of chronic obstructive pulmonary disease (COPD) is multifactorial, and the risk factors include both genetic and environmental factors. Although tobacco smoking is an established risk factor for COPD, many other associated factors remain underappreciated or neglected. Upto 50% of cases of COPD can be attributed to nonsmoking risk factors. This article describes the role of tobacco smoking and the various environmental risk factors associated with the development of COPD. © 2014 Elsevier Inc.

Gold L.S.,University of Washington | Thompson P.,University of Western Australia | Salvi S.,Chest Research Foundation | Faruqi R.A.,Merck And Co. | Sullivan S.D.,University of Washington
Respiratory Medicine | Year: 2014

Background Data on the impact of asthma in many countries in the Asia-Pacific region is limited. This study investigated whether partly- and uncontrolled asthma were associated with increased medication use/healthcare utilization and productivity loss among a population of asthma patients from nine Asia-Pacific countries. Methods We used cross-sectional data from 3630 asthma patients ≥12 years from the 2011 Asia-Pacific Asthma Insights and Management (AP-AIM) survey. Using Global Initiative for Asthma (GINA) guidelines, patients were categorized as having well-controlled, partly- controlled, or uncontrolled asthma. Chi-square tests were used to assess the relation of degree of asthma control with utilization of asthma medications, health services, productivity, and mood. Results Overall, 7.6% of the patients surveyed had asthma that was well-controlled, with the highest proportions in Singapore (14%) and the lowest in India (0%) and China (2%). Patients whose asthma was not well-controlled reported greater use of asthma medications, more emergency healthcare visits or hospitalizations for their asthma, and more interference of their mood due to asthma. They also reported significant decreases in productivity due to asthma. Conclusions Patients who did not have well-controlled asthma had greater utilization rates of asthma medications and healthcare services and were more likely to report missing multiple days of work/school compared to patients whose asthma was well-controlled. These associations suggest that emphasis on improving asthma control could have dramatic effects on patient well-being and utilization of healthcare resources. © 2013 Published by Elsevier Ltd.

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